Multimorbidity Patterns of Asthma Exacerbation in an Older Cohort: Prognostic Implications.

Abstract

Asthma frequently coexists with other diseases associated with poor asthma control and low quality of life. Asthma exacerbation refers to severe episodes of disease worsening. Few studies have focused on identifying multimorbidity patterns in asthma and assessing their effects on asthma exacerbation. To identify distinct multimorbidity patterns associated with asthma exacerbation in an older cohort and evaluate their impact on prognosis. We performed a mini batch K-means clustering analysis of the comorbidities of 849 patients with asthma in this retrospective cohort study. Logistic regression analysis was performed to quantify independent associations between the identified phenotypes and outcomes. We identified four multimorbidity patterns in patients with asthma. Clusters 1 (n = 232; 27.33%), 2 (n = 122; 14.37%), 3 (n = 149; 17.55%), and 4 (n = 346; 40.75%) were characterized by predominantly allergic, predominantly respiratory, predominantly cardiometabolic, and fewer comorbidities, respectively. Cluster 2 was at significantly increased risk of intensive care unit admission (odds ratio [OR] = 2.30), noninvasive ventilation (OR = 2.68), mechanical ventilation (OR = 1.93) and 1-year emergency department revisits for asthma (OR = 3.10). Cluster 3 had the highest risk of 1-year readmission for comorbidities (OR = 2.53) and 1-year emergency department revisit for comorbidities (OR = 1.84). We identified four multimorbidity patterns associated with clinical characteristics and adverse outcomes in patients at risk for asthma exacerbation. Comorbidities can be recognized as treatable traits that can minimize the risk of future exacerbations and the adverse effects of asthma.